Pediatric
The EDM+ is the world’s first dedicated pediatric cardiac function and fluid status monitor to measure both flow and pressure.
EDM+ can be safely used to guide fluid management and monitor hemodynamic changes in pediatric patients, using the minimally invasive pediatric Doppler probe (KDP72), placed orally in sedated or anaesthetized patients. The optional connection of an arterial line for pressure monitoring mode is now available, offering quick, easy calibration at the touch of a button.
Designed for surgical and intensive care applications, EDM+ and the pediatric probe can be utilized in the following instances:
- Sepsis
- Major abdominal surgery
- Laparoscopic surgery
- Transplant procedures
- Cardiac procedures
- Trauma procedures
- Spinal surgery
A pediatric specific nomogram, based on patient height, takes into consideration the unique anatomy and physiology of the pediatric population. As with adult patients, the calibrated Pressure Monitoring Mode allows for extended continuous monitoring in pediatric patients.
The EDM+ and pediatric probe are suitable for patients:
- ≥ 3kg
- ≥ 50cm tall
- < 16 years old
Access the Pediatric brochure for further reading.
For a list of studies validating the EDM+ in pediatric patients, click here.
Pediatric Case Studies using EDM+
Postoperative Warming
Screenshot 1
3 week old newborn, Wt 3.6 kg (8 lb), Ht 58 cm (23 in), BSA 0.22 m2. Postoperative bowel resection.
A optimal, clear Doppler signal is defined by the tidy green line around the waveform, orange/white around waveform edge (more white along downslope) with a dark center and correct arrow placement. Gain was adequate.
The newborn had fluid management in the operating room guided by the EDM+ and was now in intensive care for postoperative monitoring. FTc is reduced and there is a small respiratory swing on the waveform. HR may be acceptable.
Screenshot 2
FTc, SV, PV, CO/I are increasing. The newborn feels warmer to touch. This may indicate a reduction in afterload due to warming after surgery. However, since the respiratory swing continued, there may now be a slight relative hypovolemia and some fluid was given.
Screenshot 3
Following the fluid, FTc, SV, PV, CO/I are increasing. HR may be increasing due to relative hypovolemia as the newborn continues to warm, or pain/distress.
Summary
The EDM+ can be used safely to assess cardiac function and its responses to interventions. It is the only technology precise enough to see small changes in flow. Flow is very responsive to even small changes in circulating blood volume as well as changes in arterial compliance.
Covert Hemorrhage and Response to Fluid
Screenshot 1
3 year old patient. Wt 15 kg (33 lb), Ht 108 cm (42.5 in), BSA 0.67m2. Intraoperative. Laparotomy and resection of abdominal neuroblastoma. General anaesthetic used and ventilated.
An optimal, clear Doppler signal is defined by the tidy green line around the waveform, orange/white around waveform edge (more white along downslope) with a dark center and correct arrow placement. Gain was adequate.
At this point in surgery, CI, FTc and PV had reduced from previous results possibly indicating an increasing afterload, yet the urine output and BP remained stable.
Screenshot 2
While monitoring the patient, 5 minutes later, the results continued to deteriorate, and blood was then seen in the suction canister. SV, FTc, PV and CO/I decrease suggesting further increase in afterload probably as a result of compensation to the drop in preload, together with an increase in HR. The waveform has also become smaller in height and width. BP at this point had also started to decrease. Fluid was given, Hb checked and a blood transfusion commenced.
Screenshot 3
Half an hour later following fluid and blood, SV, FTc, PV and CO/I have increased as preload increased as well as a reduction in afterload. HR has also reduced and the waveform has increased in height and width.
Summary
In this scenario, the EDM+ indicated covert bleeding.
The EDM+ is the only technology precise enough to see small changes in flow. Flow is very responsive to changes in circulating blood volume, whereas pressure can often be maintained due to compensation. Hypovolemia is unlikely to be missed when flow is measured by the EDM+ because of its superior precision. Fluid can then be given safely in small amounts, thus preventing over or under filling of the patient.
Postoperative Trauma
Screenshot 1
14 year old patient. Wt 30 kg (66 lb), Ht 151 cm (59.5 in), BSA 1.10 m2. Multiple trauma following motor vehicle accident – suffered massive hemoperitoneum, chest trauma with pneumothorax, facial and abdominal trauma. Postoperative monitoring in intensive care following facial suturing, splenectomy and exploration of blunt trauma to liver. Ventilated and sedated.
An optimal, clear Doppler signal is defined by the tidy green line around the waveform, orange/white around waveform edge (more white along downslope) with a dark center and correct arrow placement. Gain was adequate.
BP at this stage was reduced. FTc is reduced probably indicating an increased afterload – the most common cause being hypovolemia. The clinician gave a rapid fluid challenge.
Screenshot 2
Following a fluid challenge, the SV has increased by more than 10% indicating fluid responsiveness. CO/I is unchanged, but FTc has also increased indicating a reduction in afterload. Further fluid was then given.
Screenshot 3
SV increased again by more than 10%. FTc, PV and CO/I also increase while HR reduces. BP however remained low and a dose of epinephrine was then given.
Screenshot 4
Following the epinephrine, flow results continue to increase and BP also increased.
Summary
The EDM+ can be used safely to assess cardiac function and how it responds to interventions. It is the only technology precise enough to see small changes in flow. Flow is very responsive to even small changes in circulating blood volume as well as changes in arterial compliance.
Abbreviations: BP – blood pressure. BSA – body surface area. CO/I – cardiac output/index. CVP – central venous pressure FTc – flow time corrected. HR – heart rate. Ht – height. IV – intravenous. EDM+ – esophageal Doppler monitor. PV – peak velocity. SV/I – stroke volume/index. Wt – weight.
